HEPATITIS B. What is it? How can you get it? How do you know if you have it? Headaches. Not feeling hungry. Fever. Feeling very tired

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1 HEPATITIS B What is it? Hepatitis B is a viral infection that affects your liver. The liver is a body part that filters toxins from your blood. Most of the time your body is able to fight off Hepatitis B by itself. If your body can t fight off the infection you may develop chronic Hepatitis B, which means that the infection stays with you for life. How can you get it? The main causes of Hepatitis B are sexual contact and injection drug use. The infection is spread when your mouth, vagina, or anus comes into contact with your partner s sexual fluids. Sexual fluids include ejaculate, vaginal fluid, and anal fluid. Hepatitis B can also be spread through non-sexual activities that put you into contact with someone else s blood, such as sharing injection drug equipment, tattoo needles or piercings, toothbrushes, nail clippers, razors or medical procedures with equipment that is not cleaned properly. A mother can also pass Hepatitis B onto a child through birth. How do you know if you have it? Many people do not show any signs of Hepatitis B. When you do show signs, they can include: Not feeling hungry Headaches Fever Feeling very tired Nausea and vomiting Jaundice, which is when your eyes or skin take on a yellowish colour To know for sure if you have it, you need to get tested.

2 Testing Hepatitis B is tested for through a blood test. This is usually done by drawing blood from your arm. Tests for Hepatitis B are usually accurate one month after the sex act or other activity that could have exposed you to Hepatitis B. Treatment There is no cure for chronic Hepatitis B. However, there are medications that can help you manage the infection. Prevention The Hepatitis B vaccine is widely available, so you can ask your doctor or visit your local health centre. Other important ways to help prevent the spread of Hepatitis B include: Use barriers like condoms and dental dams during sex Do not share drug equipment such as needles or pipes Make sure you are aware of the health inspection certificates of the tattoo or piercing parlour before getting tattooed or pierced Make sure you see the tattoo artist or piercer open new needles and throw-out used needles You can also choose to engage in sexual activity that does not pose a high risk for spreading Hepatitis B such as giving or receiving a massage, mutual masturbation, or sharing a sexual fantasy You can also ensure that you and your partner have been tested and do not have Hepatitis B before engaging in sexual activity Funding for this document is provided by Indigenous Services Canada. The opinions expressed in this document are those of the authors and do not necessarily reflect the official views of Indigenous Services Canada.

3 HEPATITIS C What is it? Hepatitis C is a viral infection of the liver. The liver is a body part that filters toxins from your blood. About 20% of people who get Hepatitis C are able to get rid of the virus without treatment. But for most people who get infected, Hepatitis C turns into a chronic infection, which means that the infection stays with you for life. How can you get it? Hepatitis C can be spread through activities that put you into contact with someone else s blood who has Hepatitis C, such as sharing injection drug equipment, tattoo needles or piercings, toothbrushes, nail clippers, razors or medical procedures with equipment that is not cleaned properly. A mother can also pass Hepatitis C onto a child through birth. How do you know if you have it? Many people do not show any signs of Hepatitis C. When you do show signs, they can include: Not feeling hungry Headaches Fever Feeling very tired Nausea and vomiting Jaundice, which is when your eyes or skin take on a yellowish colour To know for sure if you have it, you need to get tested.

4 Testing Hepatitis C is tested for through a blood test. This is usually done by drawing blood from your arm. Test results will take a few days to a few weeks to come back. Treatment Hepatitis C can be cured in most people with medication. For many people treatment lasts three months. Prevention There is no vaccine to protect you from Hepatitis C. Some ways to help prevent the spread of Hepatitis C include: Use barriers like condoms and dental dams during sex Do not share drug equipment such as needles or pipes Make sure you are aware of the health inspection certificates of the tattoo or piercing parlour before getting tattooed or pierced Make sure you see the tattoo artist or piercer open new needles and throw-out used needles You can also choose to engage in sexual activity that does not pose a high risk for spreading Hepatitis C such as giving or receiving a massage, mutual masturbation, or sharing a sexual fantasy You can also ensure that you and your partner have been tested and do not have Hepatitis C before engaging in sexual activity or sharing equipment Funding for this document is provided by Indigenous Services Canada. The opinions expressed in this document are those of the authors and do not necessarily reflect the official views of Indigenous Services Canada.

5 CHLAMYDIA What is it? Chlamydia is a bacterial infection that can cause pain, burning, or itching in the penis, vagina, or anus. It can also cause unusual liquids (discharge) to come out of the penis, vagina, or anus. How can you get it? You can get chlamydia through vaginal or anal sex with a partner who has chlamydia. The infection is transmitted when your vagina or anus comes into contact with your partner s sexual fluids. Sexual fluids include ejaculate, vaginal fluid, and anal fluid. Chlamydia may also be spread through oral sex on a penis, though this is not common. How do you know if you have it? Many people do not show any signs of chlamydia. This is especially true if the infection is in the mouth, vagina, or anus. When you do show signs, they can include: New or unusual discharge from the vagina, penis, or anus A burning feeling when peeing Pain in your lower abdomen Pain during sex Bleeding from the vagina or anus after sex To know for sure if you have it, you need to get tested.

6 Testing Testing for chlamydia involves peeing in a cup. Your urine will be sent to a lab for testing. If you have signs such as unusual discharge, your healthcare provider may also take a swab using a long q-tip or tiny brush. Most tests give accurate results 2 weeks after the sex act that may have exposed you to chlamydia. Treatment Antibiotics cure the infection completely if taken properly. Be sure to take the medication as directed by your healthcare provider and finish all the pills in the bottle. Prevention You can reduce your risk of getting chlamydia by using barriers such as condoms and dental dams during oral, vaginal, and anal sex. You can also choose to engage in sexual activities that do not pose a high risk for spreading chlamydia such as giving or receiving a massage, mutual masturbation, or oral sex. You and your partner can get tested before engaging in sexual activity to ensure neither of you has chlamydia. Funding for this document is provided by Indigenous Services Canada. The opinions expressed in this document are those of the authors and do not necessarily reflect the official views of Indigenous Services Canada.

7 GONORRHEA What is it? Gonorrhea is a bacterial infection that can cause pain, burning, or itching in the penis, vagina, or anus. It can also cause unusual liquids called discharge to come out of the penis, vagina, or anus. How can you get it? You can get gonorrhea through oral, vaginal, or anal sex with a partner who has gonorrhea. The infection is transmitted when your mouth, vagina, or anus comes into contact with your partner s sexual fluids. Sexual fluids include ejaculate, vaginal fluid, and anal fluid. How do you know if you have it? Many people with gonorrhea do not have any signs. This is especially true if the infection is in the mouth, vagina, or anus. If you do have signs, they may include: New or unusual discharge from the vagina, penis, or anus A burning feeling when peeing Pain in your lower abdomen Pain during sex Bleeding from the vagina or anus after sex To know for sure if you have it, you need to get tested.

8 Testing Testing for gonorrhea usually involves peeing in a cup. Your urine will be sent to a lab for testing. If you have signs such as unusual discharge, your healthcare provider may also take a swab using a long q-tip or tiny brush. Most tests give accurate results 7 days after the sex act that may have exposed you to gonorrhea. Treatment Antibiotics cure the infection completely if taken properly. Be sure to take the medication as directed by your healthcare provider and finish all the pills in the bottle. Prevention You can reduce your risk of getting gonorrhea by using barriers such as condoms and dental dams during oral, vaginal, and anal sex. You can also choose to engage in sexual activity that does not pose a high risk for spreading gonorrhea such as giving or receiving a massage, mutual masturbation, or sharing a sexual fantasy. You and your partner can get tested before engaging in sexual activity to ensure neither of you has gonorrhea. Funding for this document is provided by Indigenous Services Canada. The opinions expressed in this document are those of the authors and do not necessarily reflect the official views of Indigenous Services Canada.

9 SYPHILIS What is it? Syphilis is a bacterial infection that can cause sores on or in the genitals, anus, rectum, and/or lips and mouth and can lead to other health complications. Primary Stage: A sore will appear where the infection entered your body. This is called a chancre. The chancre can be round, firm, painless, and sometimes wet. The chancre will disappear on its own, usually 3 to 6 weeks after it appears. Because many people do not see the sore, you may not even know that you have it. Late Stage: If untreated, secondary syphilis turns into late syphilis (also called latent or tertiary syphilis). This can develop from 2 to 30 years after primary syphilis takes place. The infection may still not show any signs at this point but the bacteria harms important organs such as the eyes, skin, bones, liver, kidneys and heart. Secondary Stage: A rash may appear on the chest, stomach, genitals, palms of your hands or soles of your feet, 2 weeks to 3 months after infection, and it may last 2 to 6 weeks. The rash usually does not itch, and can sometimes be hard to see. You may also feel sick like you have the flu. Neurosyphilis: At this stage, syphilis can affect the brain. When the brain is affected, changes in personality can occur, as can problems with thinking clearly and memory. Neurosyphilis can occur at any stage of syphilis.

10 How can you get it? You can get syphilis through oral, vaginal, or anal sex with a partner who has syphilis. The infection is transmitted when your mouth, vagina, or anus comes into contact with the syphilis sore on your partner s mouth, vagina, or anus. Transmitting syphilis from mouth to mouth contact, like kissing, is very rare. To know for sure if you have it, you need to get tested. How do you know if you have it? Many people with syphilis have no signs. When signs of infection do happen, they usually take two to three weeks to appear. If left untreated, syphilis will go through different stages. Testing Usually, testing is done by taking a sample of blood, but if you have a sore, the medical practitioner might take a swab of the sore. A test for syphilis will not show up positive until 3-4 weeks after the bacteria has been transmitted. Treatment Syphilis is very easy to treat using antibiotics during the early stages. Syphilis can be treated during the later stages as well using a different length and dosage of antibiotics. But remember, once syphilis starts causing problems with your organs, the damage that is done cannot be undone, so it s important to get tested regularly. Funding for this document is provided by Indigenous Services Canada. The opinions expressed in this document are those of the authors and do not necessarily reflect the official views of Indigenous Services Canada.

11 HIV/AIDS What is it? Human Immunodeficiency Virus or HIV is a virus that attacks the immune system. If left untreated, HIV can lead to Acquired Immunodeficiency Syndrome or AIDS. There is no cure for HIV, but with treatment, people with HIV can lead long and healthy lives. How do you know if you have it? How can you get it? You can get HIV through vaginal or anal sex with a partner who has HIV (if your vagina or anus comes into contact with your partner s sexual fluids). Sexual fluids include ejaculate, vaginal fluid, and anal fluid. You can also get HIV through non-sexual activities that put you in contact with someone else s blood that has HIV, such as sharing needles like injection drug equipment or tattooing needles. HIV can also be spread from mother to child during pregnancy, labour, birth or through breastfeeding. If the mother is being treated for HIV, the chance of passing HIV onto the child is very low. Many people with HIV do not show signs after infection. Sometimes it can take years for the body to show signs of infection. If you do have signs, they may include: Fever Headaches Chills Rapid weight loss Not feeling hungry Testing Testing for HIV happens through a blood test. This can be done by drawing blood from your arm, or by pricking your finger to get a few drops of blood. Tests that use the finger-prick method are called rapid HIV tests and can provide results within minutes of being tested. To know for sure if you have it, you need to get tested.

12 Treatment Antiretroviral Therapy (ART) is used to treat HIV and it usually includes taking a combination of three antiretroviral drugs daily. There is no cure for HIV, but people living with HIV on ART can live long and healthy lives. Prevention You can reduce your risk of getting HIV by using barriers such as condoms when engaging in sexual activities and by not sharing needles. You and your partner can get tested before engaging in sexual activities or sharing needles to ensure neither of you has HIV. PrEP and PeP What is it? PrEP Pre-exposure prophylaxis or PrEP is a medication taken daily that you can take to protect yourself from getting HIV. PEP Post-exposure prophylaxis or PEP is a medication you can take to protect yourself from getting HIV. When do you take it? Before HIV exposure After HIV exposure z Take within 3 days or 72 hours after possible HIV exposure Why would you take it? How effective is it? z If you have sex partner(s) with HIV z If you don t know the status of your sexual partner(s) z If you share drug injection equipment If taken properly, PrEP can reduce the chance of getting HIV from sex by over 90% and from injection drug use by over 70%. z In emergency situations z If you have been sexually assaulted z If you don t know the status of the person you had sex with or shared drug injection equipment with If taken properly, PEP can prevent HIV infection, but it is not always effective. The sooner you take PEP (within the 3 day period) the better chance it will work. Did you know? z PrEP and PEP are covered by the Non-Insured Health Benefits Program? If a person living with HIV on ART has an Undetectable viral load (meaning there is little HIV in their blood) for at least six months, the virus is Untransmittable (meaning you cannot give the disease to someone else). This is also known as U=U. z People with HIV and their partner(s) can lead safe and fulfilling sex lives. Funding for this document is provided by Indigenous Services Canada. The opinions expressed in this document are those of the authors and do not necessarily reflect the official views of Indigenous Services Canada.

13 TRANSFORMING OUR RESPONSE TO SEXUAL AND REPRODUCTIVE HEALTH Purpose This fact sheet is intended to give service providers a background on: Trauma-informed care; Why trauma-informed care is important; and Tips on providing trauma-informed care. What is trauma-informed care? A trauma-informed approach to care recognizes how common trauma is and how this trauma affects all aspects of people s lives, including their interactions with service providers in order to create a safe space for clients. When working with Indigenous women, girls and gender diverse people, a trauma-informed approach acknowledges how the process of colonization continues to impact their lived experiences, as well as their social determinants of health. A trauma-informed approach does not mean reliving or reflecting on a trauma experience, but instead emphasizing the strengths developed from surviving trauma and how that resiliency can foster healing. Failure to take a trauma-informed approach can cause re-traumatization, which may leave the client feeling unsupported or blamed and may discourage them from seeking your services or similar services again. Why a trauma-informed approach to sexual and reproductive health is important: Sexual and reproductive health education and interventions will have increased success when service providers learn to address the possibility of traumas such as sexual abuse or violence, only after building a trusting relationship. The Public Health Agency of Canada (2015) has stated that, women who face multiple forms of stigma and discrimination, such as racism and homophobia, are particularly vulnerable to STBBIs because they are more likely to be excluded from support networks and services. As a result of processes of colonization, Indigenous women, girls, and gender diverse people face multiple forms of stigma and discrimination such as sexism, racism, classism, and ableism. Colonial strategies of assimilation such as the Indian Act, the residential school system, and the Sixties Scoop attempted to eliminate Indigenous languages, cultural practices, traditional knowledge, and kinship systems. The trauma from this history and ongoing colonial policies is still felt generations later; this is commonly referred to as intergenerational trauma. Intergenerational trauma continues to be reinforced through racism and systemic discrimination within the healthcare and social service systems. A recent example of the racism and systemic discrimination within the healthcare system is the forced and coerced sterilization of Indigenous women and girls in Saskatoon, Saskatchewan.

14 Tips on how to provide trauma-informed care: Recognize the impacts of colonialism on the lives of Indigenous women, girls, and gender diverse people. It is crucial that service providers acknowledge the impacts of colonialism through processes like the residential school system, the Sixties Scoop, the ongoing theft of land and resources, gender-based discrimination within the Indian Act, and the forced sterilization of Indigenous women in order to establish healthy relationships and harbor safe environments for our clients. Reflect on how your personal values and beliefs influence your interactions with clients. All of us carry a set of values that have been formed by a variety of influences over our life course and these values can be either visible or invisible. Service providers are no different and navigate their work lives through their own values, beliefs, and assumptions. We need to question how structural racism has been built into the health and social service system and how this impacts our ability to provide services and Indigenous women, girls and gender diverse people s ability to receive services in a dignified and respectful way. Recognize and respect that traditional knowledge and biomedicine can coexist and can be integrated into sexual and reproductive health interventions. For example, traditional ways of sharing information, such as storytelling and sharing circles can be used in a powerful way for Indigenous people to reclaim and share their stories of misconception, pain, trauma, and stigma while also reconnecting to culture. Sharing circles have potential to be healing and can take a trauma-informed approach. They are a crucial way to help Indigenous people learn and unpack their perceptions of sexual and reproductive health, and to help destigmatize conversations about healthy sexuality, sexual health and harm reduction. It s through these conversations that we will begin to turn shame into resilience. It is important to consider the following if you are working with Indigenous women, girls, and gender diverse people: What is the relationship of your client between their community and family? What is your client s home life like? Does your client have a support system? Are you aware that the word Indigenous encompasses three distinct groups (First Nations, Inuit & Métis)? Indigenous women, girls, and gender diverse people are strong and resilient, focus on their strengths instead of their deficits. Tips for service providers on giving traumainformed care: You do not need to know what trauma a person has gone through to provide traumainformed care; Be aware of your own positionality; Practice empathetic listening with clients; and Empower your clients to make the best decision for their sexual health. To further your understanding of traumainformed care, consider further exploring the concepts of forced sterilization of Indigenous women, intergenerational trauma, vicarious trauma and cultural safety. References: HIV/AIDS Epi Updates. (2010). Public Health Agency of Canada. Retrieved from epi/2010/6-eng.php Funding for this document is provided by Indigenous Services Canada. The opinions expressed in this document are those of the authors and do not necessarily reflect the official views of Indigenous Services Canada.